Health insurance solutions for Massachusetts municipalities

Your challenge

My town needs options to control costs. What can Fallon do to help that others can’t?

Your solution

Fallon Health has an established history of working with cities and towns throughout Massachusetts to help them maximize savings. We provide long-term solutions for both active employees and retirees—in-state and out-of-state. We will work with you to develop a customized plan built to:

Drive down health care costs

Offer comprehensive benefits and care programs for your employees

Comply with Section 21 of the Municipal Health Insurance Reform Act

Offer employees access to high-quality health care from the providers they want to see.

Our dedicated municipal sales team will work with your team to determine plan options to maximize savings, develop a competitive benefit structure and price point, and create and deliver member and provider education.

Plan options with Fallon Health

Sample municipal plan design

Benefit

Sample cost-sharing

Deductible

$300 individual/$600 family

Preventive care

$0

PCP office visit

$20

Specialist office visit

$60

Prescriptions

$10/30/65

Emergency room

$100 copayment, then subject to deductible

Inpatient hospital

$300 copayment, then subject to deductible

Same-day surgery

$250 copayment, then subject to deductible (maximum of four copayments per calendar year)

High-tech imaging (CAT, PET, MRI scans)

$100 copayment, then subject to deductible

Out-of-pocket maximum

$4,000 individual/ $8,000 family

Direct Care

Massachusetts’ original limited network plan offers members access to over 26,000 providers.

A subset of our larger Select Care network, custom-built around some of the state’s premier physician groups.

Delivers up to a 10% premium savings over our broader network.

Select Care

Access to a state-wide extensive network of doctors and community-based hospitals throughout Massachusetts and southern New Hampshire.

Offer Select Care alongside of Direct Care and save even more.

Preferred Care

A Preferred Provider Organization (PPO) product that has an extensive national and regional network comprised of hundreds of thousands of providers to give your employees the greatest flexibility in where they receive care.

Fallon Companion Care

A comprehensive Medicare Supplement plan

Accepted nationwide by any provider who accepts Medicare.

Offers secondary coverage for any service covered by Medicare Part A or B and pays your annual deductible.

This plan also covers Massachusetts state-mandated services which may or may not be covered by Medicare.

Anonymous Compliance Hotline: Call our Compliance Hotline to report any concerns you may have regarding compliance, fraud, waste or abuse. You can call the Hotline 24 hours a day, seven days a week. All calls are anonymous and confidential.